Provider Demographics
NPI:1235342809
Name:BRENNER, S PAIGE (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:S PAIGE
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 BOOTHE CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6709
Mailing Address - Country:US
Mailing Address - Phone:407-327-1765
Mailing Address - Fax:407-339-2129
Practice Address - Street 1:1912 BOOTHE CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6709
Practice Address - Country:US
Practice Address - Phone:407-327-1765
Practice Address - Fax:407-339-2129
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6240101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6240OtherLMHC